First and Last Name
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Email Address
*
example@example.com
Gender
*
Male
Female
Are you over the age of 18
*
Yes
No
Which service are you enquiring about? *
*
Eyebrow Tattooing
Lip Tattooing
Tattoo Removal
Are you currently using any medication?
*
Yes
No
Are you able to use topical anaesthetics? (lignocaine, tetracaine, prilocaine, epinephrine)
*
Yes
No
Are you pregnant, planning pregnancy or breastfeeding?
*
Yes
No
Do you have oily skin?
*
Yes
No
Have you had the area tattooed before?
*
Yes
No
Do you have health concerns?
*
Yes
No
Are you iron deficient or anaemic?
*
Yes
No
Do you suffer from keloid (raised) scarring?
*
Yes
No
Have you ever had a cold sore?
*
Yes
No
Do you suffer from anxiety/depression?
*
Yes
No
Please send some clear photos of the area you are enquiring about (natural lighting, no filters or makeup, back camera on phone (not the selfie camera)
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Additional Information (if you answered yes to any of the above please provide details as well as what you are hoping to achieve):
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